Download nutrition in parkinson`s disease: commonly asked questions

NUTRITION IN PARKINSON’S
DISEASE: COMMONLY ASKED
QUESTIONS
Julie H. Carter, R.N., M.S., A.N.P.
This chapter is a synopsis of some of the key dietary issues for o
m the national organization or an affiliated
center.*
Why is healthy nutrition so important in Parkinson’s
disease?
In all people, a well balanced diet is an essential foundation for
feeling good and having maximal energy. This becomes even more
important in Parkinson=s disease because there are risk factors that can
decrease food intake. Slowness of feeding, social isolation,
swallowing problems, decreased appetite, constipation and nausea
secondary to Parkinson medication can all decrease the amount of
calories consumed and result in weight loss and poor nourishment.
This can be compounded by dyskinesia (e.g., involuntary movements
caused from medication) which uses extra calories resulting in more
weight loss.
What can I do about weight loss?
Weight loss is very common in Parkinson=s disease. It can be
the result of many factors described above. The first step is to visit a
dietician who will evaluate how your Parkinson=s symptoms are
contributing to your weight loss, identify the food you enjoy and
develop a weight gain plan to fit your individual needs. It is often
helpful to eat six small meals a day and eat foods that are high in
calories and easy to swallow. If swallowing is a problem, please see
the chapter on swallowing for helpful tips.
Can diet help constipation?
Fiber and water are essential in keeping the bowel functioning.
Fiber is part of the structural material in plants; whole grains, dried beans,
fruits and vegetables are common sources of fiber. Some fiber is
insoluble, meaning it does not dissolve in water. It remains in the bowel,
soaking up water and adding bulk to the stool. This bulk stimulates the
bowel and promotes easy evacuation of the stool. Water becomes
essential in keeping the stool soft.
To prevent constipation, a person should eat 15-25 gms of insoluble fiber
a day. In addition, drinking 6-8 glasses of water a day will keep the stool
soft and easy to evacuate. For additional information, see the unit on
constipation.
Should I take my Parkinson medication with food?
All Parkinson medication has the potential for causing nausea.
Taking medication with food decreases the possibility of nausea or other
gastrointestinal side effects. Carbidopa/levodopa is the one exception to
taking medication with meals. To achieve the most predicable
absorption, carbidopa/levodopa should be taken 15-30 minutes before
meals. When taken on an empty stomach, it quickly enters the large
intestine and is absorbed into the blood stream. If taken with meals, it
does not enter the intestine until the entire meal has been digested which
may take 2-3 hours. The one exception to this rule is when
carbidopa/levodopa is first being started. In the early stages of taking this
medication, a person may experience nausea and therefore the drug
should be taken with meals. Over approximately 1-2 months, the side
effect of nausea subsides and the medication should then be taken on an
empty stomach.
Should I eat a low protein diet?
Protein is made up of amino acids. One group of amino acids
called large neutral amino acids (LNAA) can compete with levodopa and
prevent it from entering the brain where it is turned into dopamine.
Altering protein in the diet is usually only necessary in later stage disease
when motor fluctuations are prominent. It has been shown that people
who experience periods of being Aon@ and Aoff@ multiple times
throughout the day can benefit from regulating the protein in their diet. If
protein restriction is thought to be beneficial, careful attention should be
made to reducing it to the recommended daily allowance. Most
Americans eat far more than this on a daily basis. The recommended
daily allowance (RDA) for protein is 0.8 gms per kg ideal body weight or
more simply 0.4 gms per pound. As an example, if a person weighs 150
pounds the RDA for protein is 60 grams per day. This daily protein can
be evenly distributed across the day or reserved primarily for the evening
meal. From the experience of people eating a lower protein diet, it has
been found that evenly distributing across the day provides for a diet that
is easier to manage.
I am worried about falling. What should I know about
strong bones?
Calcium is the most important factor in maintaining bone
strength. The recommendation for adults over the age of 50 is 1200-1500
mg/day. Calcium is found in all milk products. For a person who is
reducing protein, an undesirable result can be the loss of calcium rich
foods.
For many people, it is desirable to take a calcium supplement.
Calcium carbonate is the best source for calcium but in some people, it
causes gastrointestinal side effects. Calcium citrate is better tolerated. It
should be noted that to absorb calcium, adequate amounts of Vitamin D
need to be taken. Vitamin D is found in fortified milk and sunshine. All
multi-vitamins have the recommended amount of vitamin D, which is
400 IU=s daily.
For post-menopausal women, estrogen replacement plays an
important role in maintaining bone strength and for all people, weight
bearing exercise also contributes to bone strength.
Should I take a multi-vitamin?
Vitamins are essential as regulators of body processes such as
metabolism of protein, carbohydrates, and fats. In Parkinson=s disease
where there is a risk for nutritional deficiencies, a multi-vitamin is
recommended. A multi-vitamin with a balance of vitamins and minerals
and no additional iron is a good choice. Extra iron should only be taken
if there is a history of iron deficiency, anemia. Iron can interfere with the
absorption of levodopa. If iron is recommended, it should be taken 1-2
hours away from a dose of Sinemet.
What should I know about taking herbs or other
nutritional supplements?
Currently there are no specific nutritional supplements that
have been proven to delay the progression of Parkinson’s disease or
treat the motor symptoms. If you decide to take herbal or nutritional
supplements it is very important that you inform your health care
provider. Some herbs may interact with prescription drugs.